Sunday, March 22, 2009


Letter to the President Elect on "Health Care Reform"

December 27, 2008

Dear President-elect Obama:

I am not a guy in the bar. I am NOT "Joe the Plumber".

I am, however, known to patients, nurses, staff, the community, and fellow physicians as "DR. JOE"

I am a board certified Family physician in practice for about 30 years. I am a senior attending physician at two University Medical Centers and Clinical Assistant Professor at two medical schools.

I have many thoughts about the state of the health care crises in this country.

The first and most central issue is to clean up the current language and thought process.

There are TWO DISTINCT, albeit interwoven, situations. Only one is in crisis. The two are HEALTH CARE and the second is HEALTH CARE FINANCING. Only the latter is in crisis. We who deliver health care are doing a fine job. Surely, there is always room for improvement, and the problems with financing adversely impact on our ability to DO a good job, but, none-the-less, WE ARE DOING A GOOD JOB.

Health care financing is a major problem, and it is entirely the fault of human nature interacting with good intentions:

Post WWII governmental tax breaks to allow employers to provide medical insurance started all the problems. Hospital costs skyrocket and physicians, primarily surgeons, had a blank check for their salary. Opportunity for greed's triumph began. Insurance companies flourished and the groundwork was laid.

Medicare, a program to act as a financial safety net for the at-risk elderly compounded the problems. It took over fifteen years for the full adverse impact to be realized, but the federal budget was already overwhelmed by the escalating cost of paying for elder-care. The rules and regulations of Medicare make the IRS code look small and simplistic!

Medicaid is a state-managed patchwork of programs that force the chronically poor and disabled into a health care ghetto. These programs, despite their TV ads to the contrary, are shameful and guarantee poor care for the neediest.

The academic invention of "Health Maintenance Organizations" was brilliant. The insurance industry saw each step as a chance to market new and greater products; the concept was totally co-opted and converted in to a macabre rationing system. The abuses of the "leaders in the field" were and are rampant. Government did nothing to improve the situation.

We are left with private and government-contracted private third parties MANAGING THE MUNDANE, rationing care, and interfering with the effective practice of medicine, while vastly inflating the cost by lining their pockets while providing no value. The national budget is swollen, trying to finance and control the health care industry". The brilliant remedies of the think-tanks are either ignored or perverted beyond recognition.

Mr. Obama: you promise real change. Here is a field that needs it desperately. What you are offering at this time, what you propose is weak, ineffective, and MORE OF THE SAME. Your proposals will fail. I fear you know that already, but that you are unwilling to offer CHANGE, REAL CHANGE.

Please prove my fears wrong. This system of health care financing does not work and cannot be simply repaired.

If I may be of any assistance, I humbly offer you my expertise in the field of medicine from the front lines.

Most Sincerely,

Joseph T. Cohn, M.D.

Family Physician, Diplomate of the American Board of Family Medicine
Clinical Assistant Professor at UMDNJ
Clinical Assistant Professor at Drexel School of Medicine
Senior Attending Physician at RWJUH and SPUH, New Brunswick, NJ

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